2016 Healthcare Workflow Predictions: Pop Health, Shared Care Plans, FHIR, Security, Feature-itis, Meaningful Use, and the Iron Triangle

Tis the season to predict! Instead of me starting from scratch, I thought I’d explore how workflow tech trends will facilitate and enable health IT trends others predict. I looked at a bunch of 2016 health IT lists of predictions (for example, see @shimcode’s list) and picked one of the best. Each of the following is adapted or inspired by one of John Halamka’s predictions in My 2016 Predictions For HIT.

1. Population Health Management On Workflow Tech

The population health management solutions that succeed in 2016 will be those that rely on some form of workflow/process/orchestration engine down deep inside. For discussion and examples, see my previous blog posts…

2. Security Threats Require Process-Aware Solutions

Those healthcare organizations that invest in workflow technology, such as business process management, will begin to understand and leverage the numerous ways in which workflow-centric solutions are more secure than data-centric solutions. For a discussion why, see Part 9 of my Health IT Workflow Integration: Whither FHIR?

3. EHR Workflow To Be Redefined

I’d like to predict that EHR workflows will become dramatically more usable, transparent, flexible, and systematically improvable, but progress here will be glacial. No, EHR workflow will be redefined by removing responsibility for workflow management from EHRs, and beginning to manage it with a process-aware, external, interacting and interfaced, layer of workflow-centric cloud-based mobile workflow apps. Of course I’ve written about this! See Part 5 of my 7000-word, 5-series Task & Workflow Interoperability from Healthcare IT News (August 3-7, 2015).

4. Groupware Over Email

Just a few years ago, “Clinical Groupware” was for a short time an extremely popular phrase (See my, Clinical Groupware: A Definition). Unfortunately, the systems described were not particularly good examples of groupware. This overhyped phrase was quickly derided and disposed. Meanwhile lightweight cloud-based groupware for managing small groups took off outside of healthcare. Groupware will indeed re-emerge in healthcare. It won’t be called clinical groupware, but that is exactly what it will be. The difference, this time around, will be that the groupware will be organized around longitudinal shared care plans. You can think of these as similar to work plans, workflow definitions and process models in the workflow management and business process management industries. Except, for the most part, human users will be the workflow engines executing these plans. Groupware organized around workflow plans are part of an ongoing evolution from traditional data-centric EHR and health IT applications, toward more workflow-centric and process-aware systems relying on workflow engines and process orchestration.

5. Market Dynamics Supercede Meaningful Use

“I don’t think a law has become so disliked since prohibition” (re Meaningful Use, Editor’s Corner, FierceEMR, 12/16/15)

Meaningful Use is a spent force, literally. The money has been spent. The carrot has been eaten. All that’s left is the stick. And that stick will be steadily whittled down. While this happens, the market forces that MU displaced for half a decade will return.

In particular, a wide variety of workflow technologies that have been diffusing into healthcare and health IT will regain traction that had been previously lost. The pent-up demand for simple-to-use clinical software, with great workflow, is tremendous. And I’ve lost count of the startups and next-state companies out their aiming to satisfy that demand.

6. Workflow-Centric Apps On Legacy Data-Centric Applications

Whatever else Meaningful Use has accomplished, it has created a multi-billion dollar industry for user interface and data interface workarounds. From speech recognition to mobile apps to EHR-lites, and from EHR database reverse engineering services to industry-wide API-ization efforts, 2016 will host a variety of compensatory technologies. For example, FHIR folks are already talking about my suggestion to incorporate task life cycle status. In particular, we will see many care management workflow tools and platforms, essentially relegating EHRs to plumbing.

7. Commoditized Workflow Infrastructure

Yes, we will see commoditized cloud infrastructures, such as Google and Amazon (both of which host workflow engines in the cloud, by the way). More important, in the long run, we will see new lightweight task and workflow engines in the cloud. Think — IFTTT, Zapier, FlowXO, and Azuqua — only between legacy EHRs and health IT systems (plus new BPM style app development platforms). These process-aware information systems are the key to patients eventually controlling the healthcare workflows intended to serve them (”owning” data is insuffient, and based on a flawed analogy to legal property rights anyway).

8. EHR Featuritis Is Treated

A critical mass of health IT thought leaders is finally coming around to view that less can be more, from a usability, productivity, and ROI perspective. More important, it is the users of these systems who are coming to despise the “feature-itis” afflicting so many EHRs today.

We will see if this particular technical debt (and conceptual debt) can be retired, or whether we will continue to be stuck with too many features and too little benefit. (I know, this isn’t technically a prediction: so, at the very least, EHR “featuritis” will become a thing.)

9. CMIOs As Orchestrators, Not Techies

CIOs will more-and more-orchestrate stakeholders and less-and less dispense technology. At the same time, CMIOs (of which I was one for a decade) will more-and-more focus on workflow and focus less-and-less on technology. Ironically, the reason that CMIOs won’t have to obsess as much about technology is that technology is getting both more powerful and easier to use. In particular, a small but influential group of healthcare organizations will (continue to) invest in a variety of workflow and process orchestration (and choreography) technologies, that will make it possible to focus more on workflow and process, and less on IT. Examples already include Ottawa Hospital and Geisinger.

10. Iron Triangle Continues to Rule Health IT

One thing never changes, though. The Iron Triangle of software development will continue to sit on the Iron Throne. Attempting to bring to market too many features to soon will result in unstable and unusable software. The only way to escape the Iron Triangle is to change the way we create software. However, this will happen so slowly, that, taken in the aggregate and on the average, 2016 will seem a lot like 2015. Nonetheless, some healthcare organizations and startups will continue to pivot from traditional health IT software development techniques toward toward faster-to-market, with more-features-to-sell, workflow-centric low-code application development.


Regardless of whether any or all of my predictions come true during 2016, I can make one prediction with great certainty and enthusiasm:

  • The healthcare and health IT social media community will be happy warriors in the thick of the fray!

PS. Many thanks to @Shimcode for inspiring (via his @MedCityNews list of 2016 HIT predictions) and then encouraging my own crystal ball gazing!

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